| 摘要: | 明代醫學的主流，主要是依循丹溪養陰降火的理論，然一般醫者學其偏，反以苦寒降火為主，因而產生了不少流弊，遂有李中梓等溫補學家的崛起以補偏救弊。李氏治病脾腎並重，為易水學派的代表人物之一。繆希雍卻承河間、丹溪之遺緒，屢起沈?重症。繆、李兩人用藥南轅北轍，然臨證療效均佳，顯示了中醫辨證論治理論的獨特性。 本文研究方法首先從繆希雍與李中梓的學術背景?手，以繆氏《先醒齋醫學廣筆記》與李氏所著《醫宗必讀》和《?補頤生微論》為研究的主要材料。針對兩人的學術理論、治病思想及用藥特色進行研究，採分析、比較、歸納、演繹等文獻研究方法，探討兩人的學術特點，並比較其異同點。並進一步探討中醫補法、清法、滋陰法則的源流及演變過程、臟腑病機辨證的要點，以期能將氣血陰陽的理論落實到臨床應用。 研究結果顯示，繆氏治病以養陰為主，重視氣、火的功能，以降為先。其治病重視脾陰用藥的思想可謂獨樹一幟，對後世溫病學家，於溫邪傷陰之用藥有很大的影響。李氏治病則以溫陽益氣為主，重視陽、氣的功能，以升為要。治病求本，重視先、後二天，博採眾長，辨疑似之證，採脈證合參。繆氏與李氏一主養陰；一主溫陽，然治病均取得很好的療效，究其因乃是兩人皆能發揮中醫辨證論治的特點，採因人、因時、因地制宜，處方用藥，依證而施。 本論文藉由對繆希雍及李中梓學術思想的研究，對於中醫學養陰、溫補、氣血陰陽理論的發展過程及臨床應用，可提供較為深入的認識，更可作為學習各家學?的階梯。; The mainstream of medical thought during the Ming dynasty was to follow Dan-Xi’s theory of enriching yin and downbearing fire. Many practitioners went too far in this by using bitter cold and fire-downbearing prescriptions to excess. The warm supplementation scholars like Li Zhong-Zi and Miu Xi-Yong rose up to remedy this harmful situation. Li was also one of the great figures of the Yi-Shui school since he recognized that spleen was as important as the kidney for treatment. Miu Xi-Yong was the scholar who upheld the tradition of Liu He-jian and Zhu Dan-Xi and therefore he treated many severe diseases. Miu and Li, while adopting vastly different approaches in the use of medicinals, both achieved clinical efficacy. They provide evidence for the effectiveness of the Chinese medical theory of pattern identification as the basis for determining treatment. The present study seeks to understand the medical thoughts, thinking processes and prescription features of Li and Miu from their academic backgrounds and takes Miu’s Xian-Xing-Zhai-Yi-Xue-Guang-Bi-Ji and Li’s Yi-Zong-Bi-Du and Shan-Bu-Yi-Sheng-Wei-Lun as the source materials. By using inductive, deductive, comparative and analytical methods, this study aims to understand the features of their medical thought and traces the origin and development of supplementation, clearing, yin-enriching methods and the chief characteristics of bowel and visceral pathomechanical pattern identification. These offer guidance for the clinical application of qi-blood-yin-yang theory. The results of the study show that Miu’s approach to healing was based on enriching yin, took the functions of qi and fire into consideration, and laid emphasis on downbearing. He was unique in emphasizing spleen yin and influenced warm disease scholars the use of medicinals in the treatment of damage to yin by warm evil. Li’s approach to healing was based on warming yang and enriching qi in treatment and took attention to functions of yang and qi, and put emphasis on upbearing. He stressed the rule that “in treatment, [one should] seek the root,” emphasized earlier-heaven (congenital) and later-heaven (acquired) constitution, highlighted the importance of correlating pulses and signs to differentiate similar diseases patterns, and united the merits or numerous masters. Miu advocated enriching yin, while Li advocated warming yang. Although their approaches were based on different hypothesis, they both obtained good results in clinic because they mastered Chinese medicine’s principle of identifying patterns as the basis for determining treatment. They both varied their prescription according to constitution, living environment, season, and pathology. The study of the medical thoughts of Miu Xi-Yong and Li Zhong-Zi helps to complete our understanding of the development of the theories of nourishing yin, warming-supplementing, and qi-blood-yin-yang and their clinical application. It represents an approach that might shed light on other theories. |
